hla-dq in acute kidney transplantation rejection

Conditions: Kidney Transplantation

Summary: - study the impact of hla-dq mismatch on acute rejection of kidney transplantation

introduction human leukocyte antigens (hla). the major histocompatibility complex (mhc) is a gene region coding for cell surface proteins important for the immune system. mhc is the most complex immunogenetic system presently known in humans . hla are groups of cell surface proteins encoded by genes in mhc which are known as hla in humans and h-2 in mice . hla genes are located on the short arm of chromosome 6 at 6p21 position , occupying a genetic region of 4mbps. the human immune system uses hla's uniqueness to distinguish self from non-self. hla are responsible for the presentation of "foreign" peptides (antigens) to the immune competent cells. t lymphocytes recognize foreign antigens only when it combines with hla molecules. humans have three class i hla (a, b, c) that are present on all nucleated cells and six class ii hla (dpa1, dpb1, dqa1, dqb1, dra, drb1) that are present only on antigen-presenting cells and lymphocytes. three of the seven heterodimers (hla-a, -b, and -drb1) contribute to the majority of immunogenicity of mismatched antigens and therefore traditional hla-typing methods have primarily focused on these alleles . renal transplantation is the gold standard therapeutic strategy of replacing renal dysfunctions that offers the best survival to the patients with end-stage renal disease (esrd). kidney transplantation is associated with 68% lower risk of death than dialysis . graft and patient survival after kidney transplantation have improved over the past decade. death-censored graft survival has increased steadily over the past decade in both adults and pediatric recipients. data provided by the scientific registry of transplant recipients (srtr) demonstrate a 10-year overall graft survival for both living and deceased donors of approximately 55 to 60 percent compared with 35 to 40 percent from a decade prior . renal transplantation success is dependent on the reaction of the immune system primarily against human leucocyte antigen (hla) proteins of the transplant. patients previously exposed to non-self hla through transplant, blood transfusions or pregnancy may develop antibodies reactive to hla . hla matching provides beneﬁts in improving outcomes in kidney transplantation and remains part of the kidney allocation. hla-dr matching has a much greater effect on graft outcomes compared with matching at the hla-a or -b locus. although hla-dq does not factor into organ allocation, its relative importance has been increasingly recognized. recipients with de novo anti-dq donor-speciﬁc antibodies have a higher incidence of acute rejection, transplant glomerulopathy, and graft loss . the effect of broad antigen hla-dq mismatching on kidney transplantation has not been clearly established. although older studies found no signiﬁcant correlation between hla-dq mismatching and graft outcomes , more recent data from the australia and new zealand dialysis and transplant registry suggested that hla-dq mismatching affects outcomes . broad antigen hla-dq matching between each recipient and donor on the basis of serologic typing is available for the majority of kidney transplant recipients in the united network for organ sharing (unos) registry . using unos data, the investigators sought to determine the effect of hla-dq matching on acute rejection and graft loss after kidney transplantation.

Eligibility criteria:
inclusion criteria: * the patients who will receive renal transplants. exclusion criteria: * recipients with pre-transplantation desensitization protocols. * recipients with history of previous transplant or pregnancy.